Book Reviews

Florian Ringel, Jörg Eriskat (eds): Current Progress in the Understanding of Secondary Brain Damage from Trauma and Ischemia. 1999; 119 pp; 28 figures; hardcover, DM 120; öS 840; sFr 109.50 ISBN 3-211-83313-7. Springer-Verlag, Vienna New York This supplement volume to Acta Neurochirurgica contains presentations given at the Sixth International Symposium on the Mechanisms of Secondary Brain Damage – New Developments that took place in Mauls/Sterzing, Italy, in February 1998. The book is organized into three main sections: molecular and cellular mechanisms, cerebral ischemia, and lasting problems from severe cranial and cerebral trauma. The subjects in the first section range from changes in the ectoplasmic reticulum as the basis of cellular damage to molecular signals for glial activation to the effects of neurotrophins and ciliary neurotrophic factor with respect to survival and regeneration of motor neurons following mechanical and exotoxic lesions. The second section, which deals with cerebral ischemia, presents contributions on ischemic penumbra, investigations on the effect of hypothermia on glial swelling, studies on thrombosis and heparin-induced extracorporeal low density lipoprotein, and fibrinogen precipitation. The final section contains studies on pediatric skull and brain trauma, a systematized patient management analysis of preclinical and early clinical phases of severe skull and brain trauma, frequency and causes of post-traumatic neurologic deterioration, the effects of apolipoprotein E and Riluzole finally on work on the challenges of applying information gained from experimental neuroprotective models to the actual skull/brain traumatized patient. In all, this collection of experimental and clinical studies represents a profile of experimental results to date concerning secondary brain trauma following primary trauma and ischemia. The book is of great interest to neuroscientists, neurologists, and neurosurgeons, especially those working in this field. Moreover, it is a valuable source of topical information for intensive care physicians, anesthesists, pediatricians, internists and all colleagues involved in the care of critically ill and injured patients.

IN giving an analytical view of this large volume, the distribution of the subjects adopted by the author will be followed ?* and though, perhaps, his arrangement is not the most perspicuous possible, yet, by treading in his footsteps, we shall present our readers with a more satisfactory account of his work, than could arise out of any attempted alteration of his plan, according to any notions of our own. The Introduction, of xxv pages, is occupied with general observations on the advantages arising out of this branch of professional study ; and in an elucidation of some particular points of importance. The peculiar advantages of the study of morbid anatomy the author enumerates under the five following heads. " 1st. This study, by elucidating the nature and progress of diseases connected with a derangement of organic structure, affords a * " The arrangement adopted differs a little from that of preceding authors; for, instead oi describing in continuance all the 01ganic derangements of the gullet, oi the stomach, or ot the intestines, I have classed under one head the same diseases in their different parts of the alimentary canal, following rather the arrangement of diseases than parts," Introd. six, sure.
Dr. Monro's Morbid Anatomy. 495 sure foundation upon which an opinion may be grounded, respecting the nature and progress of such diseases. " 2d. As the study proves that parts similar in their structure are subject to the same organic derangements, it exposes the fallacy of many hypotheses which have been propagated respecting organic diseases. " 3d. If parts of a similar structure be subject to similar organic derangements, morbid anatomy may tend to unfold the structure of many of the smaller parts of the human body, which have hitherto escaped observation, as it shews that many of these smaller parts are subject to the same organic derangements as those organs whose structure is obvious to our unassisted senses. "4th. Morbid, like comparative, anatomy, assists in distinguishing those organs which are essential to life, from others of less importance, and also shews that every part, even of the same bowel, is not equally sensible or equally necessary to the prolongation of life. " 5th. This study points out the uncertainties and deficiencies of many parts of medical science, and particularly as to the method of cure; and hence may pave the way to a new and improved method of treatment." These general observations on the advantages arising from examining and understanding the diseased alteration of structure in various parts of the animal frame, are illustrated by the particular examples of diseased liver, hernia, and.stricture of the urethra. " The pressure of the enlarged liver may interrupt the functions of the stomach; or the same cause, impeding the free circulation of the blood through the different bowels of the belly, as well as through the liver itself, may produce a dropsy of the belly. The enlarged liver is the source of still further mischief; by pressing upon the gall ducts, it impedes the free passage of the bile into the intestinal canal; and the bile thus obstructed, passes off by another channel, and is taken up by the lymphatic vessels, occasioning jaundice. Nor is this all the evil to be apprehended from the affection we are considering. By means of inflammation, the enlarged liver may be united with the neighboring parts; and if, in such a situation, an abscess should take place within, the contents of the abscess might be discharged into the general cavity of the belly, into the sacs of the pleura;, or even into the lungs. " The progress of the disease called rupture, or hernia, affords another and very striking example of the importance of the study of morbid anatomy; for even the most accurate knowledge of the anatomy of the body, in its sound state, conveys but an imperfect idea of the state of the displaced parts, or of the state of the canal through which the displacement has been propagated. The displaced portion of the intestine pushes before it the thin, slippery,* and elastic, peritoneum, which lines the belly; and, after such an occurrence, the lining soon loses its natural characters, being con--verted 41)6 Critical Analysis.
Verted into a dense, Iamellated, membrane, which frequently coft* tracts adhesions with the neighboring parts. The intestines, daring the different stages of the disease, are more or less twisted, compressed; arid often inflamed. By consequence of the displacement, their coats become thicker, as also the neighboring cellular substance. " Of the preceding remarks, the disease called stricture of the urethra affords a very strong illustration. In the earlier stages of the (this) disease it only produces ji membranous growth, which, in its future progress, is converted into ligament, and even into cartilage; and the neighboring parts are frequently reduced to the same morbid state. In addition to the pain and difficulty in discharging the urine, the usual concomitants of stricture, the disease often occasions various constitutional symptoms: among these may be enumerated great nervous irritation, despondency, in some cases bordering upon delirium, and, in other cases, symptoms similar to thosfr which accompany an ague." If the examination of diseased parts, post mortem, according to the rules of anatomical science, and with a reference to the symptoms during life, had needed a recommendation to those who feel the value and the advantage of collecting facts, Dr. Monro's Introduction would be particularly valuable; and, should there be any professional persons who still doubt the importance of this species of investigation, ive refer them to the arguments here employed. Before we proceed to a view of the contents of this volume, "we,shall venture a few cursory observations on the language employed in it, as well as in some other works, of the present period.
Morbid anatomy for the anatomy of diseased parts? Morbid poison for the contagious or infectious material generated in certain diseases?Female complaints for the diseases of the female sex?are expressions of doubtful import at best; and would always mislead without a previous pariphrastic explanation. This affected conversion of words, made, perhaps, with a view to compression, has done much toward destroying the perspicuity of the language of science.
According to accepted usage, they express something verydifferent from what is intended. Thus a female complaint is a disease of the feminine gender?morbid anatomy is the science itself in a state of disease. A thousand analogies will prove this to be the precise sense of the language: a gratuitous admission at first, may, in time and by custom, however, give to this phraseology, perhaps, a legitimate establishment. In the fluctuations of taste, many wilder innovations may arise; or we may return to the" old standard. *' Multa renascentur, quae jam cecidere; cadentque, Qu<e nunc sunt in honore vocabula, si volet usus; Quern penes arbitriuui est, et jus, et norma loqueudi," Much Dr. Monro's Morbid Anato'mi}. 4 *c Much phrase that now is dead, shall be reviv'd; And much shall die, that now is nobly liv'd, ' If custom please; at whose disposing will The pow'r and rule of speaking resteth still.'* The practice of others has usually been brought in excuse of employing what is incorrect in itself. Thus far Dr. Monro is supported in the title of his Work; but we think it strange that arprofessor in a liberal and learned science, at one of the first schools in the world for teaching that science, should employ colloquial barbarisms in place of the language which the science itself furnishes, and which all his readers would.better understand.
Why should the disgusting term gullet be substituted for the naturalized oesophagus? The doctor apologises for his language on the ground of his being employed on subjects of more importance. Perhaps he is so employed; but lie should be aware that neatness, perspicuity, and even elegance, of composition, are compatible with, and essential to, the success of his labors, when he presents those labors to the public. The language of his dissecting room, like his dissecting dress, may be negligent and coarse; but we should be hurt to descry the professor of medicine, anatomy, and surgery, issuing into the streets and public places enveloped in a greasy gown, and an old. leathern travelling cap on his head. If the language of this volume is redundant without perspicuity, if familiar without ease, the author has injured medical literature by his example, " The better sort should set before them ?A grace, a manner, a decorum ; Something that gives their actions light, Not only makes them great, but bright." Prior.
Having ventured thus far, en passant, on a subject we deem of some importance, especially in this age of invention and coinage, when new terms start up da/ily, to " fright the language from its propriety," we proceed to the body of the work. 0. An enumeration of the causes which lead to an enlargement of those neighbouring organs, which, by pressing upon the alimentary canal, prove a mechanical obstruction to the progress of its contents.
Our readers will perceive the rich and interesting harvest which the subject promises, and expectation will not be disappointed.
" The greater part of the diseases of the alimentary canal, included in the above six classes, tend to obstruct the passage of the alimeht to a greater or less degree; creating, in some instances, a permanent, in others only a temporary, obstruction. " The permanent obstruction, by stricture, is of slow growth, but constant in its operation, and becomes greater and greater, either from the gradual increase of the concretion or tumor occasioning it, or from the gradual approximation of the opposite sides of the canal; whereas, the stricture from spasm comes on suddenly is generally of short duration, and the spasmodic contraction frequently goes oft* spontaneously, or after the exhibition of proper remedies. " But upon some occasions the spasmodic contraction is not rejnoved during life; and upon dissection we find the muscular coat of ?m unnatural hardness. " There is in some constitutions a remarkable disposition to diseases which obstruct the alimentary canal. I have met with several patients who have been so unfortunate as to labor under two very different causes of obstruction at the same time, or in succession. " The symptoms, originating from very different causes of obstruction, are in some respects similar; the patient suffers much from a severe tightness, pain, and soreness, in the diseased part. " The mucous membrane being much irritated, the mucous, which is secreted in an extraordinary quantity, instead of being a mild fluid, becomes thin, of a light green or yellow color, and acquires on unnatural acrimony, so as sometimes to excoriate the neighbouring parts; and it is discharged in considerable quantity from the moitth, by hawking, or along with the feces. " Those mucous glands and their ducts, which are situated above the seat of the obstruction, being much irritated, attain an unnatural size, whilst those under it are not at all affected. " The above symptoms are occasionally aggravated by catching cold*; and, in these circumstances, and from the irritable nature of the * We would be glad to see the popular and vague term, catching cold, expelled frotu works of science. What does it strictly and . truly Dr. Monro's Morbid Anatomy. 49? <hc patient's constitution, an unnatural local spasmodic contraction is sometimes excited, which aggravates his sulFerings. " The constitution is at first but little affected, but, in consequence of the continuance of the obstructing cause, the digestive powers are much impaired. The patient loaths his food; what is taken becomes acid ; he loses his spirits ; and is occasionally very costive; but at other times much weakened by a bilious diarrhoea.. He becomes weak and emaciated, and has a quick pulse: he suffers after a time very great pain, owing to the distention by air. " The air accumulated in the stomach and intestines, sometimes distends these organs to such an uncommon size, that the convolutions of the intestines may be distinctly felt through the parieties of the abdomen. " I have seen the stomach and intestines distended to two or three times their natural size, and sometimes even ruptured by the Unnatural distention. "It has been matter of dispute among physiologists, from what source the air is derived. " It is not compatible with the object and limits of this volume, to enter at large into this question, which has afforded matter for much controversy. I shall therefore only observe, that, as far as I can judge, a part of it is swallowed, a part is formed by secretion, and a part is generated by fermentation. " As we sometimes meet with cases, where the distention, although so considerable as to occasion great pain and uneasiness, yet has gone off gradually, and without the discharge of air by the mouth or anus, it is probable that part of the accumulated air lias been taken up by the absorbent vessels. " From the abdomen being tense like a drum, where the stomach and intestines are distended by air; the name tympanites has been employed by nosologists, to express this morbid state. " As the air 'sometimes escapes from the intestines into the general cavity of the abdomen, in consequence ot wounds, ulceration, and other diseases, nomologists also describe the tympanites abdominalis.
" It is of some moment to distinguish the one species of tympany from the other, the former being a much less dangerous affection than the latter. truely mean? Sometimes it meetsx us in the form of catarrh, or bronchitis^ now it limps in rheumatism, suffocates in asthma, and our Professor employs it to aggravate the symptoms ot obstruction in the intestinal canal. In short, it is the scane-goat of all our sins, with respect to the causes of disease. What is the cause of my complaint says the patient? The reply of the nurse, the apoT thecary, the surgeon, the physician, and the professor, is, you have caught cold. Thus have we gone on from age to age, but surely it is now time to question the validity of this catching cold. It may continue to be the shibboleth of old women, but the term should be discarded by men of sense and science. oOO Critical Analysis. " The abdominal tympany comes on suddenly, the belly is uniformly distended in whatever posture the patient is, and also smooth; the patient is not sensible of wind moving within his bowels, nor does he hear the sound of it; and he is not relieved by passing wind, nor is the distention of the belly diminished by a purgative.
"The intestinal tympany, on the other hand, cornes on very gradually, the turns of the intestines may be traced by a careful examination; and the sound of the air, passing from the contracted to the dilated position, may be perceived. " Besides, the patient is sensible of air moving from one place to.
another; and, whilst the air passes from one turn of the intestine to another, he suffers pain, the intestines being generally spasmodically straightened. The patient also discharges an usual quantity of air, upwards and downwards, by which he is much relieved. Section 2.?" Of Obstructions in the Alimentary Canaly occasioned by Alvine Concretions." In this section is given a more extensive history of human alvine concretions, than is elsewhere to be met with; the materials for which have been principallyfurnished from the extensive collection of these substances made by Professor Monro, senior: four plates are annexed, which considerably elucidate the subject.
The 502 Critical Analysis.
The symptoms indicating the existence of these concretions are stated to be irritation, functions of the stomach and intestines, impaired and altered, much griping and sometimes acute pain. " The pain in the bowels, in some cases fixed to one part, is much more severe upon one occasion than another, especially after taking acids, or food of difficult digestion, and is frequently attend-; cd by nausea and vomiting. " Some piatients are much constipated for two or three days, and have yet a constant inclination to go to stool. Others have watery stools, and discharge, along with these, a quantity of a viscid ropy mucus, or blood; after which they are much relieved. " Some patients discharge their stools involuntarily. " Upon relaxing the parieties of the abdomen, a very hard, painful, globular, tumor, may generally be felt, most frequently in the eourse of the large intestines. It can seldom be made to change its plan within the intestine; but often appears to do so in consequence of the change of place of the intestine which contains it.
Hence the change appears greatest when the concretion is within the small intestines or arch of the colon, which, from the length of the mesentery or mesocolon, are very moveable. " The digestive powers being much impaired, the patient becomes very weak and much emaciated; and, from the continuance of the disease, is reduced to a skeleton.
"The pulse, in the earlier stages of the disease, is but little affected. " Upon the alvine concretion changing its place, and passing down into the sigmoid flexure of the colon, or into the rectum, it creates excruciating torture in the region of the pelvis, and the bowels become much distended, from the passage being suddenly interrupted, and the patient apprehends instant death." Several cases are subjoined illustratiye of the phenomena, management, and termination, of this species of disease of the intestinal canal; and, from his view of the subject, the Professor thinks he has established the following propositions; " 1. That the greater number of Alvine Concretions are made up of fibres, which are intimately matted together, and which probably have been attracted by a central nucleus.
" o. That A. C. occasion a derangement of the functions of the alimentary canal, and create griping, obstinate, and long-continued, colicky pains, which are generally limited to that part of the intestinal canal which contains tiie concretion, and which are occasionally more severe upon the patient taking acids, or food of difficult digestion.
"3. That A. C. may generally be felt within the intestines, and that when two or more of these, are lodged within the intestines, these may be made to strike against each other. " 4. That A. C. frequently change their situation, and pass down into the rectum, which is thereby much extended, and, when so si-tuated, occasion acute pain and sense of weight in the back part of the pelvis, which is attended by a constant desire to go to stool, which the patient cannot gratify; and they may, by a finger, or by an instrument, introduced into the rectum, be felt within it. " 5. That A. C., formed within the human alimentary canal, are, in some cases, discharged by vomiting, or along with the fceces. " 6'. That an A. C., after a certain time, cannot be moved from one portion of the alimentary canal to another, owing to its increase in bulk, to the expansion of the coats in that part which contains the concretion into a sac, and to the unnatural constriction immediately below the seat of the Alvine Concretion. " 7. That A. C. must prove a mechanical obstruction to the passage of the aliment through the intestines ; and, if proper means be not taken to remove the cause of the obstruction, inflammation follows, which proves fatal. " 8. From the chemical analysis of the concretions, it is evident \ that Alvine Concretions are of a very peculiar nature, and different from all vegetable and animal productions; and that solvents, sufficiently powerful to act upon those concretions within the intestines, cannot he employed, with impunity, to give the least hope of decomposing those substances within the body, and evacuating them in the ordinary way. " 9. That, in the earlier stages of the disease, while the concretion may be moved from one part of the intestines to another, alt that can be done, is to operate on the bowels, partly through the medium of mechanical action, and partly by lubricating the alimentary canal by the exhibition of proper medicines, in order that the concretion may be discharged along with the feces, or may descend into the rectum, from which it may be artificially extracted.
" 10, That after the disease has beeu of long standing, and when a sac has been formed, which retains the concretion in a certain place, it cannot be removed, should it be lodgedwithin the colon, but by an incision." Dr. Monro, sen. had suggested that the incision mentioned in proposition x. might, under certain circumstances, be employed writh a fair chance of saving life; and a case is given in this volume (page 58), in which, it is probable, such an operation would have been successful.
Section 3.??" Of Calculi of the Tonsils." Of this very uncommon disease, two cases are inserted.
Of the calculi, three in number, in these cases, a description is given by Professor Jameson, and a chemical analysis by Dr. Thomson. Section 4.?Treats of the " Ejfects of Arsenic." In this section are contained several experiments made on animals with arsenic in its metallic state, and with the artificial sulphurets of this substance. From these experiments it appeared " that the metallic arsenic might be taken by dogs with impunity, to the extent of several grains." it produced 504 Critical Analysis, produced, however, in these cases, some disturbance in the first passages, and its exhibition was followed b}r a considerable flow of urine. Section 5.?11 Of the Effects of Opium." It might be expected that the medium through which opium acts on the system'would not now be doubtful ; the contrary, however, is the fact. The late Dr. Whytt asserted, that this substance affected the system by the,medium of the nerves only. That experimental physiologist Fontana, was equally positive that the blood was the medium. " My father's numerous experiments," says our author, u led him to a different conclusion/ He supposes, that opium not only affects the nerves, to which it is primarily applied, but is also absorbed ; and, being then mixed with the blood, proves fatal, by its sedative powers upon the nerves of the heart and blood-vessels, and the whole nervous system." When opium has been swallowed in a deleterious quantity, two distinct sets of symptoms arise. These are " vertigo, torpor, slow and full pulse; breathing at first quick, difficult, and stertorous, and it gradually becomes slower, so that there is a distinct intermission between the inspirations. The pulse gradually becomes more feeble and slower, as the breathing becomes slower. The patient falls into a profound sleep, from which he does not awake, and dies : apoplectic, and sometimes is much convulsed. In other eases, vomiting takes place, and the patient becomes afterwards paralytic." The great object is to remove the poison from the stomach, and this is to be done by emetics. Of those Professor Monro .recommends, in preference to all others, sulphate of zinc in solution, in doses of Bj. to 3fs. The greater part of the section is employed in describing an instrument for conveying fluids into the stomach. The second section of this chapter (the first section con*? ? tains only a synopsis of its arrangement) treats of inflammation of the villose coat. There are three facts in this section, which, as having come directly under the author's observance, may not be deemed uninteresting to our readers. It has v;ery generally been understood, that redness and turgescence of the neighbouring arteries are essential to inflammation of the intestines. Dr. Monro has seen, however, " the bowels of patients who died with all the symptoms of inflammation, of a sea-green color; which color could not: be imputed to putrefaction, as the body was (bodies were) examined a short time after death." In three cases, the author saw the internal membrane of the pharynx thrown into a state of high inflammation, in consequence of the bite of a mad dog. " The color of this inflammation was vert/ peculiar; it was not a brilliant red, such as that produced by vermilion, but the purple red, such as carmine or lake gives." In the body of a woman who died of diabetes, he " observed, an appearance in the intestines similar to that occasioned by inflammation. Upon a more accurate examination, the red. color was found owing to a red jelly effused between the peritoneal and muscular coats of the intestines." In this inflammation of the villous coat, the mucous, instead of being a mild, transparent, viscid, fluid, is rendered opake, white, sometimes ropy, and even frothy. Section 3.?" Thickening of the Villous Coat." The villous coat, from repeated inflammation, remains in a thickened, spongy, and irritable, state; and the common* occurrence of effusion of coagulable lymph adds very much to this thickening. The general description is illustrated bycases, and the fact rendered more obvious in Plate XIV. In the Museum of Edinburgh there are several specimens of coagulable lymph being thrown into the cavity of the intestine in such quantity as to take the form of the cavity, and, being discharged peranum, were deemed to be worms of a very unusual kind and size. preternatural communications between neighbouring parts, from the adhesion preceding the ulcerative process. " The symptoms which denote ulceration of the villous coat, are, slight hot and cold fits ; hectic flushing of the face ; pain in the part affected, becoming less acute, and detumejaction of the belly; pulse fuller and slower, often irregular." In the progress of the disease, " the patient becomes very thin, and very weak, and also very costive, hot, thirsty, and feverish, and in this state languishes for a few months; at length he is affected by stupor and delirium, and dies completely exhausted." Section 5.?<( Gangrene" <l Inflammation of the villous coat rarely terminates in gangrene." In this section there are many practical remarks, for which we must refer our feaders to the work itself. It also contains a detail of the symptoms of hydrophobia, and a minute history of a case; but, why inserted here, we do not fully see; because, in the fauces, larynx, pharynx* oesophagus, stomach, and the whole.of the abdominal viscera, there was not the slightest morbid appearance. In a distant part of the volume we find the " symptoms of mortification of the villous coat." P. 151. Section 6.?tC Of Inflammation, Ulceration, and Erosion, of the Villous Coat from Dysentery.'''' The history and symptoms of dysentery are here detailed from a manuscript of the author's uncle. Dr. Donald Monro. The concluding part of the section we would gladly insert, as containing some general facts respecting the habits of the mucous membrane ; but, when wo look to the number of pages yet to go over, we are compelled to forbear. This tumor, which our author considers as having entirely ?escaped the attention of pathologists, he describes as having some analogy to the anomalous tumor of his grandfather, to the spongoid inflammation oi Burns, and the fungous hsumatodes of Hay; and also to that organic disease of the testes, described by Baillie under the head of pulpy testicle. " I have called it, says Dr. M -, milt-like tumor, as it resembles in color and consistence the milt of many fishes; and liave added the words mucous membranes, because it grows only from membranes of that description. part with water, forming a turbid mixture ; and is somewhat hardened by being put into strong spirits. It adheres but slightly to the organ from which it grows, by a number of small processes, which insinuate themselves into the villous coat, which has attained an unnatural thickness; and, when the tumor has been detached the villous coat of the diseased bowel assumes somewhat of a honeycomb appearance, and it is besmeared by several drops of blood which are derived from the vessels which extended to the tumor being torn. > " The bowel from which such a tumor grows externally, betrays marks of inflammation; there is evidently an unnatural determination of blood to the seat of the disease, the blood-vessels upon' the peritoneal coat being not only larger, but also more numerous thaa in the healthy state. " There is another peculiarity in the disease, viz. a verv remarkable offensive fcetor; and the organ, containing such a tumor, is as much discolored, and emits as foetid a smell, as the bowel which has been exposed to the air for several days." An endeavor is made to give the characteristic marks of this tumor which distinguish it from the tumor to which it ?was compared in the preceding part of the section, accompanied with a colored plate, (No. Y.) drawn from a case here related by Mr. C. Anderson, of Leith. Section 8.?" Of Polypi." In this section the varieties of polypus are described, under those of the pharynx, the gullet, and the stomach, with an annexed plate, (No. VI.) taken from the disease of a patient, whose case is given. Section 9.?" Steatomatous Tumors." The author has not seen an example of this organic disease of the villous coat of the alimentary canal, of course nothing satisfactory is said on it. In every case of stricture of the oesophagus, stomach, or Intestines, which the author has seen, all the coats of the part affected have been constricted, " so that there was an appearance as if a cord had been drawn very tightly around the diseased part of the alimentary canal." Baillie and Home are particularly referred to, but why are not the later and interesting publications of Copeiand and White noticed ? Section 14.?" Of Aptlue," and 1.5, "Small-pox Pustules -within the Alimentary Canalafford no remark that will "be at all interesting, except that the pustules of small-pox in the intestines is " an extremely rare" occurrence. Section 10.? " Deposition of Cartilage and Bone upon the Villous Coat of the Alimentary Canal.u The parts of the canal most subjected to this disease, are the oesophagus, colon, and rectum. When the cartilaginous stricture happens to the rectum, the symptoms are described to be, First, "a slight difficulty in making water; this is followed by nausea, impaired digestion, colicky pains, tenesmus, and habitual costiveness. The feces have not their usual size and shape, but resemble small earth-worms, and are expelled only after a considerable effort; and, when the patient is very costive, blood is sometimes discharged with the excrement; and generally a quantity of fcetid mucus, ichorous, or purulent matter. When the disease has been of some duration, solid fceces cannot pass; and the contents of the intestines are discharged in a liquid form, and even these are passed only after a considerable effort." We now come to the second general division of this chapter, " Organic Derangements of the Cellular Coat of the Mivientary Canal,1' to which, with an unfortunate anomaly as to the construction of the volume, is continued the term section. According to the synoptic view (p. Ill) it contains three subdivisions: phlegmon and its consequences; albuminous tumors; and diseases which originate in the other coverings of the intestines. As we have professed tQ Dr. Monro's Morbid Anatomy. 509 to follow our author precisely, we must, with him, call this second general division section 17. This section contains general observations on inflammation of the cellular coat, and its consequences, abscess, &c. Section 18, is on a subject of considerable novelty and interest, " the Deposition of albuminous Matter m the cellular Coat of the Alimentary Canal. " This organic derangement is of a very peculiar nature, and very generally affects at the same time different bowels of the abdomen and pelvis, and also the lymphatic glands in the vicinity. " In the earlier part of the disease, we observe small hard tumors, about the size of a pea, in the cellular substance, which grow inwardly, and which push before them the villous coat.
In the more advanced stages, the diseased bowel attains an unnatural hardness and size, and its coats are prodigiously thickened in some places. Tumors of a pyramidal figure grow inwards from the thickened parieties, by which the diameter of the affected part is much lessened. Upon making a section of the coats, we observe the peritoneal coat somewhat harder, whiter, and thicker, than common, but no appearance of the cellular and muscular coats, for their place is occupied by the albuminous substance." The liver, testes, uterus, and lymphatic glands, are all subject to this disease, and have their texture and appearance exceedingly changed by it : as it appears in the liver, it is here the subject of a particular description.
The third subdivision has no more than its title.
The third general division, " Organic derangements of the muscular Coat of the Alimentary Canal," making the ]gth section, contains inflammation and its consequences, spasm, and palsy. The contraction of the middle of the stomach, as stated by Mr. Home, is admitted to be nearly correct; and, in the part appropriated to spasmodic contractions of the intestines, the species or varieties of colic, in nosologists, are sh?"htlv treated of. From this pait we extiact the following passage, on the possibility of ascertaining the seat of the? contraction by the symptoms. pressed, feel hard and knotty, tenesmus, and obstinate costiveness, are pathagnomonic symptoms of the painter's colic." The muscles of the palsied extremities, consequent on this species of colic, not only lose their natural size, but have their structure converted into a suety substance; as has also happened in rachitis, in scrofula, and in that disease called osteosarcoma.
The ?0th section, still subjected to the anomaly before noticed, constitutes the fourth general division of this chapter, and comprehends the te Organic Derangements of the Peritoneal Coat.'''' The subdivision of this treats of inflammation?Section 21, small tumors growing from the peritoneal coat?Section 22, ossification of the peritoneum? Section 23, hydatids.
The last of these subdivisions, under the denomination of section 23, treats very fully on the obscure form of animal life in the hydatid; and from which the following corollaries are deduced: " 1st. That hydatids are not peculiar to any one part of the human body, and (but) are most commonly connected with the' investing membranes of the liver, ovaria, or kidney. " 2d. That there is no resemblance bet\i?een the hydatids which aie peculiar to quadrupeds, and those of the human body, as is obvious, by comparing the preceding description of the hydatid ojf the human body, with those of the hydatids of quadrupeds, which have been published by Hartmannus, Tyson, Pallas, Schroeder, Fontana, and E. Home. " 3d. That there is every reason to conclude that hydatids are animals. " 4th. That observation and experiment have not yet determined in what manner hydatids are generated, or deposited, within certaia bowels.
" oth. That, as the smaller hydatids adhere to the inner surface t)f the larger, the larger hydatids may be called pregnant; or that these animals are multiplied, like some vegetables, by the adhesion of the smaller hydatids to the coats of the larger hydatids. " 6'tli. That the coats of the bowels containing the hydatids are much more frequently destroyed, than when water only has been collected witljjn them; hence the hydatids escape from their original situation, and sometimes find their way by unnatural passages into the intestines, urinary or biliary canals, windpipe, &c. " 7th. That many patients recover upon the discharge of the hydatids. " 8th. That hydatids may, even when adhering to one of the bowels of the abdomen, be removed by incision, provided there exists an adhesion between that viscus and the parietes of the abdomen." The fifth general division, called section 24, treats of " Organic Under this division are investigated the various degrees and situations of stricture of the alimentary canal, scrofula of the intestines, coats of the alimentary canal reduced to a pulpy state, induration of the coats of the intestines, dilatation and rupture of a part of the alimentary canal, organic diseases of the mucous glands of the alimentary canal, scirrhus and cancer of the gullet, stomach, pylorus, and intestines, scirrhus rectum, enlargement of the mucous glands of the alimentary canal.
Three plates accompany this part?No. 8, representing a fatal stricture of the oesophagus; No. 9, a cancer of the oesophagus; and No. 10, stricture occasioned by cancerous tumors at the cardia, and cancer of the stomach.
The third Chapter treats of those obstructions which " originate from a Displacement of a Portion of the Alimentary Canal." These causes of obstruction are Inius-susceptio, Procidentia A?ii, and Hernia. Section 1.?<( lntus-siisceptio." This derangement occurs much more frequentty in infancy than in advanced life. It is of " two very distinct kinds, that which is unattended by inflammation, and that attended by acute inflammation and its consequences. The former, which occurs generally during infancy, in most cases does not merit the name of a disease, as it does not derange the functions of the alimentary canal; whereas the latter, which may be ranked among the diseases of manhood arid old age, is one of the most acute and fatal disorders incident to humanity." . The phenomena that distinguish the mtus-susceptio, accompanied with acute symptoms, from inflammation of the intestines excited by other causes, are stated to be, " The sudden appearance of the symptoms after violent straining at stool, the impossibility of throwing up by the anus as much liquid as in a state of health, together with the sudden appearance ^ of a hard tumor on the left side of the abdomen, and which is puinful on pressure." / The progress of the disease is well marked in a case from Professor Monro, sen. with a plate, No 21.
Connected with this derangement or the intestinal canal, is the discharge of a portion of intestine by stool. Alarming as this appears, it is not always dangerpus. An instance is here given of fifteen inches of the ilium being brought away by stool, and ths patient havipj good health for many years after. Section, 53-2 Critical Analysis. . Section <2, 11 Procidentia Aniis so connected with section 1, that it is barely mentioned here.
Section 3, " of Herniais important and extensive, occupying the volume from page 3G3 to54<2; and is illustrated by several plates.
To give such an analysis of this section as would be at all satisfactory to our readers, would occupy more space than can be allowed to it; we must therefore refer to the work itself, and only observe, that the author has brought together much curious matter both anatomical and ehirurgical, on every species and variety of the disease.
Chapter IV. " Of Mai-formations of the lower Part of the Alimentary Canal,'''' is confined to a description of malconformations of the rectum, under eight varieties.
1st, and most common, is that in which the rectum is covered (when it should terminate in the anus) by the common teguments, or by a membrane of considerable thickness. r 2d,-When the membrane which obstructs the rectum is internal.
3d, Unnatural contraction of the rectum. 4th, Where the rectum terminates in the bladder of urine, urethra, vagina, or womb. 5th, The rectum terminating in the vagina, through which the fosces arc discharged. 6th, Where the rectum is sometimes entirely aw anting ? (wanting).
7th, Where the rectum opens through the os sacrum. 8th, Where the rectum has been continued through the vagina, and lias terminated external to the vulva. Chapter V. " On the JVorms which infest the human Alimentary Canal," gives a short detail of the history and anatomical structure of the Tenia solium, T. dent at a, T. lata; the Ascar is vermicular is, A. lumbricoides; and the Trichuris hominis.
Of the last, the Trichuris hominis, as being a more rare species than the former, we shall insert the professor's description.
' " The body is about an inch long, and it has a filiform tail* about an inch and a halt in length. " Different authors vary in their opinions respecting the anatomy of this worm. According to some, the animal has a proboscis, which it can eject at pleasure; according to Goeze, that is the penis of the animal.
" The stomach and intestines form a long canal, which proceeds from the head to the extremity of the worm, and is largest at the beginning; is much smaller at the tail of*the animal. " The ovarium, which frequently contains ovula, and a limpid fluid, Mr. Crowther's Remarks on Insanity. 5IS fluid, is a convoluted canal, and similar to that of the female Ascari.3 vermicularis." We had been made to understand, that after chapter five there was to be a sixth, to consist " of an enumeration of the causes which lead to an enlargement of those neighboring organs, which by pressing upon the alimentary canal, prove a mechanical obstruction to the progress of its contents." But we have not found it in its promised place. Upon the importance of the subject of this volume there will be but one opinion?upon the quality of the materials with which it is formed, there will necessarily exist diversity of estimation?upon the style in which it is written, and upon the employment of low and popular terms in the place of those consecrated to science, we have been free in our animadversions. But, if we should be thought to have fallen into any semblance of severity, we deprecate the charge. Our duty to the profession, and to ourselves, required that we should speak out; and this Ave have done in the spirit of perfect charity with Professor Monro. When we see men in high stations negligent of appearances in their public acts, we feel for the credit of themselves and of the profession to which the}7 belong; and we tremble for the effect of precedent. Among physiciansvwe may still find correct, energetic, and elegant, writers: the Augustan age of medical literature has not yet passed away; we cannot, therefore, permit the example of this volume, the chance of debasing the style of medical compositions, without an effort to avert the evil.
Practical Remarks on Insanity/, to which is added, a Commentary on the Dissection of the Brains of Maniacs ; with some Account of Diseases incident to the Insane. By Bryan Crowther, Member of the Royal College of Surgeons in London, and burgeon to Budewell and Bethletn, Hospitals. Svo. pp. 130. Underwood; London, 181 J. As far as opportunity and situation can contribute to enable a man to obtain knowledge in a particular and interesting branch of the profession, Mi. Crowthei is eminently favored. If we are disappointed in the quantum and quality of information which has been the lesult of those favorable circumstances, perhaps we raised oui expectations too high. Our chief view, however, in analysing medical publications, being to extract whatever is curious and useful, we shall endeavor to select the most valuable parts of this treatise, and enable our readers to decide upon the author's pretensions.
The first section treats of the causes of insanity, and the KQs iO'O, 3 u " author 614 Critical Analysis. author candidly states that he is very ignorant of them:, the; concluding paragraph contains the sum of his information on that head. " As to the,general cause of insanity (observes Mr. C.) I l<no\r nothing; and my ignorance is less to be regretted, as the celebrated Cullen declares, that, as ' we know there have been many instances of insanity from which the persons have entirely recovered, it is difficult to suppose that any organic lesions of the brain had taken place.' Thus much I advance in support of the general cause of madness, not having its origin in an altered texture of this organ; and, aS to those who are incurably insane, it matters not whether they possess one condition of the brain or the other, and whether it be the cerebrum aridum of Morgagni, or the mania corporea of Dr. Cullen." P. 21.
The appearances of the brain and its membranes on dissection, are dispatched in a short section. They are stated to consist " in opacity of the arachnoid membrane, which was sometimes occasionally thickened; a preternatural determination of blood to the membranes as well as the brain ; together with an effusion of water between its membranes, its convolutions, and into the ventricles." In some instances ossification of the arteries occurred, and the pineal gland was charged with sabulous matter; but all these appearances frequently exist when there has been no insanity. Mr. Crowther therefore regards them as the effects rather than as the causes of mental derangement. He states (we much regret he has not mentioned his authority) that " One anatomical teacher of acknowledged eminence entertained the opinion that the brains of maniacal persons were always morbidly affected; but, after having examined a number of additional cases, and not observing in many heads any vestige of actual disease, he was led to the conclusion that the cause of insanity did not consist in diseased affection of the brain. " Another gentleman, whose anatomical skiil is also acknowledged, inspected, in Bethlem hospital, several heads at my retpiest, some of which he declared, had they been examined elsewhere, he should have pronounced to have had no unusual appearance." P. 26.
Mr, Crowther has taken some pains to investigate the effect of local diseases in cases of vesania. From the result of his experience, it seems that surgical complaints have no influence on mental derangement. It has been supposed by some individuals, that insanity secured the patient from the attacks of epidemics ; whilst others have asserted that these complahits not only affected maniacs, but tended to their cure.
The following table affords only scanty evidence, but sufficient, in our opinion, to set aside the first supposition, and to render the second doubtful, Fxom 1733 to ' N v 1793, 1753, twenty-seven patients took the natural small-pox in Bethlem hospital. Or these, 18 died; one was discharged sick and weak; five recovered from the small-pox, and were cured of their insanity ; three recovered from the small-pox, but remained incurably mad. The deaths of course cannot be admitted as evidence on either side the question. We must therefore look at the number of recoveries from mania after small.pox, which we find was in the proportion of 5 to S; but this, Mr. Crowther observes, forms " nearly the aggregate of mad persons who recover without the intervention of this malady" (small-pox). " It appears, from the books of Bethlem hospital, that not quite.a half, but more than one third, of its patients are discharged cured of their insanity.'' P. 5 J.
The facts at present before us certainly are insufficient to determine the question: we have merely concurred with our author's opinion, founded on the evidence which he has adduced, and by no means presume to draw any general conclusion from such partial instances. The subject is curious, and we should be glad to receive information upon it. The following case, in which small-pox seemed to produce a favorable, effect, as far as a solitary case can have weight, deserves consideration. " W. K. an incurable patient (in Bethlem) took the infection: he was conveyed to the Small-pox hospital, July 16'th, 1794, and returned to the charity August 14th following, well of the small-pox, and restored to his senses. This person's case is the more worthy of attention, as he was on the incurable establishment, and that his violence of demeanor was such, that it became necessary to chaiu him to his apartment." He continued well about eight months, and was discharged; but in a fortnight was again brought to the hospital in a state of insanity, which was attributed to irregularity and intemperance during his short absence.
In the three succeeding sections the author treats of mortification of the feet, and nates, and sphacelus of the toesj but it does not appear that these affections in maniacs require a different treatment from that which is usually pursued when they occur in other cases. The section on management contains little novelty, as Mr. Satisfied with such answer, he made no reply, nor ever after mentioned the subject. "Another patient imagined himself to be, Jesus Christ; and, in proof of it, shewed me a scar he had in his side, which he said had been occasioned by his having been pierced with a spear. I remonstrated with him on his assertion, and remarked, that our Saviour was wounded on the' side opposite to that he had indicated as the part wounded in himself. Convinced, and apparently ashamed, at the consciousness of the fallacy of his own reasoning, the patient recoiled, hid himself under the bed-clothes, and never reverted to the impression under which he had previously labored." P. <54.
The section on the medical treatment of the insane, is chiefly extracted from preceding writers. In undertaking this task, the author states his " principal view has been to collect and concentrate the practical ideas of others in such a manner as will render more useful this tract, upon this intricate but interesting subject." We conceive we have now given the cream of Mr. Crowther's publication. Should our readers, however, be of a different opinion, we recommend them to purchase the volume, We have often had occasion to notice the industry of Mr. Bullock in collecting, and the taste displayed in arranging, his immense stores of natural history; and which he has now deposited in a building erected for their reception, under the denomination of the London Museum.
The visitors to this place of amusement and rational gratification had to regret that they often left it. with little information or distinct knowledge of what they had seen and' cursorily admired ; because a descriptive guide or catalogue raisonne'e, which might direct them through this wilderness of the beauties of nature, and bring them acquainted with the established facts, or rational conjectures that applied to the individual specimens, was wanting. This desideratum is in a measure supplied by the little work now before us: it, however, by no means reaches our idea of what such a catalogue might be made j and, thougn in' its present state exceedingly useful to those whose curiosity leads them to this depository, it might go much further, and become a directory to the whole system ot created things, the specimens of which, found here, would illustrate the text Companion to the London Museum. 517 text in a way infinitely superior to the most finished engravings. With this view, every specimen should have, at ieast, its generic and specific name, and its native place, with a reference to the best authorities.
When the specimen was new, or non-descript (of this kind we meet with many), all the facts respecting it which have come to the knowledge of the ingenious collector, should be scrupulously given. The Linnaean arrangement, for we have no idea of any that can excel it, in the extended view we have suggested, should be continued ; the species wanting to fill up the genera might be noticed (in a foot note), as affording a probable means of acquiring those species; and we see no reason why, in a place like London, secure from the desolations of war, commanding wealth beyond calculation, and holding an intercourse with the whole habitable earth, the plan of Mr. Bullock might not be pushed on to a complete collection of Natural History. We should be glad to see, in addition to this, a library and extensive Herbaria. We acknowledge this coup d'ocil to be vast, but the powers of man, bent to one object, and supported by public approbation, are not to be estimated. " All the performances of human art, at which Ave look with praise or wonder, are instances of the resistless force of perseverance; it is by this that the quarry becomes a pyramid, and that distant countries are united by canals. If a man was t5 compare the effect of a single stroke of the pick-axe, or of one impression of the spade, with the general design and last result, lie would be overwhelmed by this sense of their disproportion ; yet those petty operations, incessantly continued, in time surmount the greatest difficulties, and mountains are levelled, and oceans bounded, bv the slender force of human beings." : It is not consonant to our plan to go into a minute investigation of this interesting subject; and it would oe superfluous to pive a regular analysis of \\ nat in itself is only an analysis; but we shall not dismiss it without doing the proprietor of the London Museum the justice or saying, that his collections in various classes of^ the systema natura are extensive, choice, and valuable. In the class of buds we have been particularly attracted by the singulai and beautiful genus Paradisea, the species of which heie deposited are numerous, and many of them rare. Of the 48 species of the genus Cuculus, we find 40 here. But of the genus rlro-cZulus (humming bird) this museum may boast, loi it contains 100 species, many of which are non descripts. The species of the classes Amphibia, Insecta, and Pisces, are also very numerous; and the collection of shells^ corals^ JYIadrepores, and minerals, respectable. The latter part of this volume contains the description of a novel exhibition, so far it regards the distribution of the subjects, under the title of Pantherion. It consists of a large collection of animals distributed throughout a tropical forest, intended to represent them as nearly as possible, in a state of unrestrained nature. The forest itself is an object of some interest, as it is formed of trees and plants of the torrid zone, modelled from nature, or the best authorities. Among them we observed Atrocarpus incisi, Agave Americana,, Alma sapientum, Passiflora quadrangular is, Dimocarpus lite hiy Annona reticularis, Querciis suber, Carica papaya, JJsidium pyreferum, Borassus jabelliformis, Urania speciesa, Cocus nucefora, &c. &c. &c.
We can recommend this little work to all those who visit the London Museum; and, should its author ever think proper to adopt the hints we have given him, it may become a useful and interesting; addition to the library of the naturalist.* * An Inquirer in our last number (page 380) will see, by the above, what assistance he may expect in his visits to Mr. Buliock's Museum. after